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    Managing pigment epithelial detachments with ranibizumab

    PRN dosing resulted in similar visual acuity gains for those with or without PEDs in HARBOR study

     

    Mountain View, CA—Large or small pigment epithelial detachments (PED) in neovascular age-related macular degeneration (AMD) can be managed effectively with ranibizumab PRN therapy with regular monitoring, said Rahul N. Khurana, MD.

    “There is a common belief out there that PED associated with neovascular AMD are quite challenging to manage,” he said. “The idea behind that is that there are often these large detachments that don't respond as well to anti-VEGF therapy and they don't do as well from a visual acuity perspective. But this belief really stems from our experience and not from a lot of evidence per se.”

    Dr. Khurana said the dilemma for most clinicians is how to treat a patient with a large PED. In the HARBOR study, 1,097 patients were randomized to 1 of 4 ranibizumab (RBZ) regimens: 0.5 mg monthly or 2.0 mg monthly and 0.5 mg PRN or 2.0 mg PRN after 3 monthly loading doses for 24 months. PRN treatment was administered based on strict retreatment criteria and guided by spectral domain optical coherence tomography (SD-OCT) disease activity or visual acuity stability.

    “Our subgroup analysis reviewed results from patients with or without PED at baseline in both the full study population (all treatment groups pooled) and by treatment regimen,” he said. “Absolute visual acuity, change in visual acuity from baseline, and number of injections in the PRN treatment groups, were summarized.”

    Preconceived notions were that patients with a PED would have a worse prognosis in at least one of those variables, and likely all three, he said.

    “What we found was almost somewhat the opposite. When it came to visual acuity, the presence of a PED did not preclude a good initial outcome. If you did have a PED, you still had a very robust visual acuity gain of almost essentially 9 letters, which is very similar to the patients who did not have a PED,” he said.

    Study results

    Of the 1,097 patients in HARBOR, 598 (54.5%) had a PED at baseline. At baseline, the mean visual acuity (ETDRS letters) was higher for patients with PED (55.7 letters) than without PED (51.9 letters). Mean change from baseline in visual acuity at month 24 was 7.9 letters in patients with PED and 9.7 letters in patients without PED, with vision being similar after adjustment for baseline covariates, Dr. Khurana noted.

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